Major Changes in Terminology of Some Early-Stage Cancers Proposed
Recently, a working group of experts who advises the National Cancer Institute (NCI), and who comprises some of the top scientists in cancer research, proposed that the terminology of some early-stage, noninvasive forms of cancer, such as ductal carcinoma in situ (DCIS), be changed.
Currently, DCIS is considered the earliest form of breast cancer, and the experts recommend it be reclassified as indolent lesions of epithelial origin (IDLE).
The idea behind this proposal is that disease labels can induce an emotional response; therefore, it may be possible to reduce patients' distress about receiving this diagnosis through a simple semantic change. In addition, it is hypothesized that reclassifying some conditions may help decrease potentially unnecessary treatments.
“The fundamental problem with the term 'cancer' when it is attached to a possibly premalignant condition is that the patient—and often the physician—think that 'cancer is cancer' and that something must be done. Many precancerous conditions have a very low risk of progressing to cancer and, even if cancer develops, it may have a very low risk of causing harm in the patient's lifetime,” said Ian M. Thompson, Jr., MD, Director of the Cancer Therapy & Research Center at the University of Texas Health Science Center, San Antonio, TX. “What needs to be done is to assign a very precise word that is linked directly with the risk of the condition. The word cancer often has a very bad connotation.”
Dr. Thompson and two of his colleagues who served as chairs of the NCI working group were charged with developing ways to improve current approaches to cancer screening and prevention. As a result, they recently published an article in the Journal of the American Medical Association (JAMA) that recommends new strategies for reducing overtreatment of cancer.1 They contend in this article that when cancer screening programs were widely initiated three decades ago, medical knowledge of the disease was more simplistic, and the intent was to detect cancer at its earliest stages in order to reduce morbidity and mortality.
However, the group argues that early diagnosis has not led to a proportional decline in serious disease and death. Instead, current screening programs identify not only malignant cancers but also slow-growing, low-risk lesions, and combine them into the same treatment process. Dr. Thompson and his colleagues suggest this is leading to overdiagnosing and overtreating of some forms of cancer that might never actually cause harm to an individual.
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Laura Esserman, MD, MBA, co-author of the JAMA article and Director of the Carol Franc Buck Breast Cancer Center at the University of California San Francisco, San Francisco, CA, said that because of advances in scientific understanding of the biology of cancer, it is time for significant changes in practice and policy.